| NPI | 1811452543 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS042033) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 16699) |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI02952400) | |
| Enumeration Date | 2019-02-06 |
| Last Update Date | 2023-08-06 |